AIDS合并中枢神经系统疾病临床特点分析

Clinical features of AIDS complicated by central nervous system diseases

目的通过分析AIDS患者合并中枢神经系统疾病的临床特点及诊治情况,以提高AIDS合并中枢神经系统疾病的确诊率和疗效,改善预后。方法回顾性分析北京地坛医院2014年1月—2015年1月住院治疗的62例合并神经系统疾病的AIDS患者临床特点及诊治情况。结果因中枢神经系统疾病人院患者占同期入院患者的9.82%。临床表现主要为发热、头痛、脑膜刺激征阳性、呕吐、肢体运动障碍、意识障碍和头晕等。隐球菌性脑膜炎20例(32.26%);神经梅毒和结核性脑膜炎各8例(12.90%);HIV脑病/进行性多灶性脑白质病5例(8.06%);弓形体脑病4例(6.45%);巨细胞病毒脑炎并神经根炎2例(3.23%);4例经脑活体组织检查,3例分别诊断为化脓性结核性脑膜炎、伯基特淋巴瘤和组织胞浆菌病(各占1.61%),1例病原仍不明;脊髓炎、疱疹病毒脑炎和颅内占位病变各1例(各占1.61%);原因不明中枢神经系统感染9例(14.52%)。经治疗,43例(69.35%)病情好转,10例(16.13%)放弃治疗,5例(8.06%)死亡,无变化4例(6.45%)。结论 AIDS并发中枢神经系统疾病原因复杂,临床确诊困难。发热、头痛、脑膜刺激征阳性、呕吐、肢体障碍和意识障碍为主要临床表现。以隐球菌性脑膜炎发病率最高,其次为结核性脑膜炎和神经梅毒。尽可能查找病原学依据有利于早期明确诊断,改善预后。

Objective To analyze the clinical features,diagnosis and treatment of central nervous system（CNS） diseases in AIDS patients,so as to improve the diagnosis,therapeutic efficacy and prognosis of AIDS complicated by CNS diseases.Methods A retrospective analysis of the clinical features,diagnosis and treatment was carried out in 62 AIDS patients with CNS diseases treated in Beijing Ditan hospital from January 2014 to January 2015.Results Patients with CNS diseases accounted for 9.82%of the inpatients treated in the same period.The main clinical manifestations were fever,headache,positive meningeal irritation sign,vomiting,limb dysfunction,disturbance of consciousness and dizziness,etc.There were 20 patients（32.26%） with cryptococcal meningitis,8 patients（12.90%）with neurosyphilis,8 patients（12.90%） with tuberculous meningitis,5 patients（8.06%） with HIV encephalopathy/progressive multifocal leucoencephalopathy,4 patients（6.45%） with toxoplasmosis,2 patients（3.23%） with cytomegalovirus encephalitis and nerve root inflammation.Of 4 patients undergoing brain biopsy,3 patients were diagnosed with fester tuberculous encephalitis（1.61%）,Berkey lymphoma（1.61%） and Histoplasma capsulatum disease（1.61%）,respectively,and 1 patient with unknown pathogen.There was 1 patient with spinal cord inflammation（1.61%）,1 patient with herpes encephalitis（1.61%）,1 patient with occupying lesions（1.61%）,and 9 patients（14.52%） with unknown causes.After treatment,43 patients（69.35%） improved,10 patients（16.13%） abandoned treatment,5 patients（8.06%） died and no change was found in 4 patients（6.45%）.Conclusions The causes leading to CNS diseases in AIDS patients are complicated,and CNS diseases are difficult to diagnose.The main manifestations are fever,headache,positive meningeal irritation sign,vomiting,limb disturbance,and disturbance of consciousness.The incidence rate of cryptococcal meningitis is the highest among CSN diseases in AIDS patients,followed by tuberculous meningitis and neurosyphilis.To investigate the pathogens of CNS diseases in AIDS patients helps make a definite diagnosis earlier and improve the prognosis.